Patient experiences with tapering of mood stabilizers in self-reported bipolar spectrum disorder

Background: This study aimed to gain insight into patient-reported experiences with tapering of mood stabilizers among patients with a self-reported bipolar spectrum disorder diagnosis in the Netherlands. Methods: A digital survey on experiences with tapering of mood stabilizers and the Functioning Assessment Short Test (FAST) was distributed via multiple online platforms to reach adult patients with a bipolar spectrum disorder diagnosis. Results: A total of 104 respondents shared their experiences with tapering mood stabilizers, of whom 86 completed the FAST. Lithium was the most reported mood stabilizer ever used (74% [76/103]) and currently used (47% [32/68]). Almost all respondents attempted tapering or discontinuation (95% [97/102]), of whom 29% (28/97) completely discontinued and no longer used a mood stabilizer. Tapering was often done gradually (85% [82/97]), frequently following a linear (34% [28/82]) or hyperbolic approach (11% [9/82]), and usually under clinician guidance (77% [75/97]). Duration of tapering varied widely, ranging from four weeks to several years. Most patients who have tapered their mood stabilizer(s) completely, do not experience functional impairment (65% [15/28]). Limitations: This study relied on self-reported data and a cross-sectional design, which may limit generalizability and prevent causal conclusions. Conclusions: Tapering of mood stabilizers is typically done gradually and the duration varies greatly. Most patients who have discontinued their mood stabilizer(s) seem to have no functional impairment. Trials comparing tapering versus continuation of maintenance treatment in euthymic patients diagnosed with a bipolar spectrum disorder are needed, with outcomes such as relapse risk, withdrawal symptoms and functioning.